When Can Young Athletes Play Through The Pain?

Published April 19, 2017

By Dr. Richard Layfield, sports medicine physician with NoVa Orthopedic & Spine care center

With the opportunity to earn scholarships, to play in college, or even to make it as a professional athlete, there is an incredible amount of pressure on talented young athletes. And while participation in athletics keeps kids healthy and moving, there is always a risk of injury to be mindful of. According to the Center for Disease Control and Prevention, each year, more than 2.6 million athletes under the age of 20 are treated in emergency rooms for sports-related injuries of all kinds.

Many young athletes feel invincible, often thinking that they can play through the pain and finish out the big game after an injury. On the other hand, as parents, it’s easy to assume the worst and head for the hospital right away. But athletic injuries aren’t always worst case scenario, and kids can sometimes finish the game before seeking medical attention if their injury isn’t severe.

What injuries are minor enough to allow athletes to keep playing? What are the lasting effects of not seeking immediate medical attention for a severe injury? While every injury and every athlete is different, let’s review some of the most common sports injuries that I see in young athletes.

Sprained Ankle
Ankle sprains are common in soccer, football and basketball. The injury occurs when the athlete lands and turns the ankle, more commonly described as “rolling the ankle.” While some sprains are more serious than others, I would typically say that if an athlete has minimal or no swelling and can run and walk without pain or limping, he or she can continue playing – after being checked out by the team physician or athletic trainer, of course. If swelling and limping occurs, it’s best to keep weight off of the foot and seek medical attention.

Sprains are more concerning in younger athletes under the age of 13, however, because they have open growth plates. At first glance, a younger athlete may appear to have a sprained ankle, but it could be a growth plate injury that, gone untreated, may have long-term effects. Instead of returning to play, children under 13 should have an X-Ray to rule out growth plate injuries, which could require surgery or close monitoring.

Dislocated Shoulder
It’s no secret that football players often experience shoulder dislocations. This is rarely a season-ending injury, but I wouldn’t recommend the player go back into the game right away. We can often manage the injury non-operatively for the remainder of the season through bracing to restrict mobility for players in certain positions, and many athletes who require surgery will elect to wait until off-season to avoid missing game time. There is a significant risk of re-dislocation, and that’s something the athlete, coaches and physicians will want to keep an eye on.

Swollen or Painful Joints
Swelling of the joints is common among collision athletes, but the athlete may not be able to identify the swelling on his own. I often have patients come into my office reporting pain but no swelling – only to identify upon examination that there is, in fact, swelling. An athletic trainer or team physician can identify swelling after a big hit or fall to determine if the player should sit the rest of the game out, but this can sometimes be difficult to detect with an untrained eye. There is always a reason for swelling and the risk for worsening the injury simply is not worth it. If swelling is significant, I always recommend the player sit out the rest of the game, but if there is no pain or swelling after a collision or hit, and if the player isn’t experiencing pain, he or she should be fine to continue playing.

ACL Tear
More serious injuries, like an ACL tear, of course keep the athlete from finishing the game. This is a pretty painful injury that requires surgery and 6-9 months of recovery time and physical therapy. The trouble with ACL tears is that often, the athlete feels well enough to play after 2-4 months of physical therapy, but it is critical that the athlete fully regain strength before going back on the field. The athlete must have clearance from an orthopaedic physician before participating in any athletics beyond physical therapy to ensure a full recovery and to avoid the risk of re-injury.

Finger Sprain or Fracture
There are also hand injuries that can be reduced on the field, such as a finger sprain or fracture. If it isn’t a severe break or sprain, the team physician or athletic trainer is typically able to tape the finger up, so long as the athlete isn’t experiencing significant pain and swelling. However, if the athlete is under the age of 13, I would again be more worried about a growth plate injury and would keep the player out of the game. Regardless of age, if you suspect a fracture, an X-Ray is necessary after the game.

Minor injuries are actually generally tougher to assess on the field. When a player experiences a seriously painful or debilitating injury, it’s clear that emergent medical care is required. However, for more minor injuries that aren’t quite as painful, it’s hard for a parent or athlete to determine if medical attention is needed – and often they wait too long to seek care. I always recommend that an athlete get checked out by a team physician or athletic trainer after a collision, trip or fall, etc. When it comes to young athletes, it’s best to play it safe to avoid further injury.

Dr. Richard Layfield is a sports medicine surgeon with expertise in arthroscopic surgery for sports medicine injuries. He has significant experience working closely with sports teams including the Minnesota Vikings, Minnesota Twins, Minnesota Timberwolves and the Minnesota Wild while completing his fellowship training in Sports Medicine at the Orthopaedic Center in Minneapolis. Dr. Layfield currently serves as a sports medicine consultant for many high schools in Prince William County. He completed his residency at the University of Illinois and received his medical degree at the University of South Florida.